BMJ  2005;330:898-900 (16 April), doi:10.1136/bmj.330.7496.898

Education and debate

Improving diet and physical activity: 12 lessons from controlling tobacco smoking

¹ Yale University, New Haven, CT, USA, ² London School of Hygiene and Tropical Medicine, London, ³ University of Queensland, Brisbane, Australia, ⁴ School of Medicine, University of California, San Francisco, CA, USA Thomas E Novotny professor in residence, epidemiology and biostatistics

On behalf of Oxford Vision 2020, a partnership dedicated to preventing the forecast worldwide growth of chronic diseases, the authors suggest that 12 lessons learnt from attempts to control tobacco smoking could be used to tackle the chronic disease epidemics evolving from unhealthy diets and a lack of physical activity

The first 150 words of the full text of this article appear below.

Introduction

This year three new books have been published about the progress made globally in research, policy, and actions to control tobacco smoking.^1–3 In addition, Sir Richard Doll reported this year on 50 years of following British doctors to document the impact of smoking on their health.⁴ We have reviewed the evidence and approaches taken to control tobacco smoking, well described in these new texts, because of the rapid global increase in the risk factors of unhealthy diets and lack of physical activity. As part of the Oxford Vision 2020 process,⁵ we have proposed 12 lessons from tobacco control that might speed up progress in tackling these new public health threats. We also drew on other recent insights from tobacco control in addressing other chronic disease risks.^6–8

1. Address the issue of individual responsibility versus collective or environmental action early and often

This issue pervades debates . . . [Full text of this article]

2. Evidence of harm is necessary, but is not sufficient to motivate policy change

3. Decisions to act need not wait for evidence of the effectiveness of interventions

4. Fully implement interventions known to be effective

5. Real and perceived needs and concerns of developing countries need to be addressed even if they involve going beyond the initial scope of the risk being addressed

6. The more comprehensive the package of measures considered, the greater the impact

7. Broad based, well networked, vertical and horizontal coalitions are key

8. Change in support for tobacco control took decades of effort led by media savvy and politically astute leaders

9. Modest, well spent funds can have a massive impact, but without clear goals funding may not be sustainable

10. Complacency that past actions will serve well in future may retard future progress

11. Rules of engagement with the tobacco and food industries need to be different and continually under review

12. Risk factor envy is harmful—a joint approach is needed

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